One of the most important and challenging aspects of child behaviour management is the control of pain. Children who undergo early painful experiences during dental procedures are likely to carry negative feelings toward dentistry into adulthood. Therefore, it is important that clinicians make every effort to minimise pain and discomfort during dental treatment.
Because of the likelihood of the paediatric dental patient experiencing discomfort during restorative and surgical procedures dentists turn to the use of local anaesthetics and/or analgesics to control pain. The simplest and most effective method of reducing pain during dental procedures is via an injection of local anaesthetic. Unfortunately, the anticipation of receiving a “shot” tends to increase anxiety in the paediatric and adult patient and similarly in the dentist who has the task of minimising discomfort during the injection process. Most adults are willing to subject themselves to the minor discomfort of the injection because they can envision the comfort they will experience during restorative and surgical procedures. Unfortunately, younger children do not have the ability to do this and thus may exhibit negative behaviour before, during and after the injection process. Many dentists, wishing to circumvent such negative behaviour, forego administering local anaesthesia for restorative treatment especially in primary teeth. However, there are times when an anticipated “minor” procedure becomes a major procedure and the patient is placed in a painful situation because of the lack of dental anaesthesia. Local anaesthesia can prevent discomfort associated with placing a rubber dam clamp, tooth preparation, pulp therapy and extraction.
There are very few contraindications for the use of local anaesthesia in children during dental procedures. However, when administering a local anaesthetic to a child the clinician should be aware of the possibilities of anaesthetic overdose, self-induced traumatic injuries related to prolonged duration of soft tissue anaesthesia and technique variations related to the smaller skull and different anatomy in paediatric patients.
The goal of this course is to familiarise the dentist and dental auxiliaries with effective and safe techniques for the administration of local anaesthesia in the paediatric dental patient. It is not intended to be the most comprehensive source of information on local anaesthesia. The reader is referred to The Handbook of Local Anaesthesia by Dr. Stanley Malamed for an in depth discussion of the topic.